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Mao M, Kuang Y, Chen M, Yan K, Lv C, Liu P, Lu Y, Chen X, Zhu W, Chen W. The HLA-Cw*06 allele may predict the response to methotrexate (MTX) treatment in Chinese arthritis-free psoriasis patients. Arch Dermatol Res 2022; 315:1241-1247. [PMID: 36513862 DOI: 10.1007/s00403-022-02498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
MTX in genetically distinctive Chinese psoriatic patients remains less explored. The present study aimed to determine the impact of HLA-Cw*06 on MTX response in a Chinese psoriasis patient population. A total of 204 patients with psoriasis were enrolled in this study. Clinical data and DNA samples from all patients were collected. The allele of HLA-Cw*06 genotyping was detected using direct Sanger sequencing. This study enrolled 204 patients with psoriasis, including 47 (23.04%) psoriatic arthritis patients, 157 (76.96%) patients free of psoriatic arthritis. Overall, 110 (53.92%) of all patients carried the HLA-Cw*06 allele. This frequency in patients with arthritis-free psoriasis was higher than that in those with psoriatic arthritis (58.59 vs. 38.30%, P = 0.014). After 8 weeks of MTX treatment, the arthritis-free psoriasis patients, who tested positive for the HLA-Cw*06 allele, showed significant improvement compared to those who tested negative (For PASI50, 78.57 vs. 55.22%, P = 0.02, and for PASI75, 51.11 vs. 34.33%, P = 0.036). The psoriatic arthritis-free patients who carried the HLA-Cw*06 allele in combination with the ABCB1 rs1045642 CC genotype showed the highest improvement. A regression model containing HLA-Cw*06, rs1045642T > C, and initial PASI scores was used to construct the efficacy prediction model of MTX, which yielded AUC values of 73.2 and 75.6% for PASI50 and PASI75 to MTX, respectively, in arthritis-free psoriasis patients. The HLA-Cw*06 allele is associated with optimal response to MTX treatment in arthritis-free Chinese psoriasis patients. When combined with clinical indicators, the polymorphism explained more than 75% of the individual efficacy differences.
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Affiliation(s)
- Manyun Mao
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Yehong Kuang
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Menglin Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Kexiang Yan
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, China
| | - Chenzhi Lv
- Department of Dermatology, Dalian Dermatosis Hospital, Dalian, Liaoning, China
| | - Panpan Liu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Yan Lu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Xiang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Wu Zhu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
| | - Wangqing Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China. .,Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
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2
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Jung JM, Jung CJ, Yang HJ, Lee WJ, Won CH, Lee MW, Chang SE. Clinical implications of facial psoriasis in children and adolescents. Pediatr Dermatol 2022; 39:528-534. [PMID: 35347761 DOI: 10.1111/pde.14986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The clinical implications of facial involvement in pediatric patients with psoriasis have not been adequately studied. The objectives of this study are to evaluate the association between facial involvement and clinical features including disease severity of psoriasis in children and adolescents. METHODS The clinical features of patients aged below 20 years diagnosed with psoriasis were retrospectively evaluated and grouped based on the presence or absence of facial involvement at presentation. Demographic and clinical data were compared between groups. RESULTS Of the 175 patients, 110 patients (62.9%) had facial involvement of psoriasis at presentation. The group with facial involvement was significantly younger at disease onset (p = .032) and had a higher body mass index (BMI) (p = .043) and psoriasis area and severity index (PASI) score (p <.001). The severity of pruritus was significantly higher in the facial than in the non-facial group (p = .020). Involvement of the nose was associated with the highest disease severity as assessed by the PASI score and affected body surface area. A significantly higher number of treatment modalities were used in the facial group than in the non-facial group (p = .013). The BMI (odds ratio (OR), 1.39; 95% CI (confidence interval), 1.07-1.80) and PASI score (OR, 1.45; 95% CI, 1.03-2.03) were independent factors associated with facial involvement of psoriasis. CONCLUSIONS Facial involvement in psoriasis was associated with higher disease severity and more treatment modalities in children and adolescents.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Joo Yang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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3
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Dhaher SA, Alyassiry F. Screening for Comorbid Cardiovascular Risk Factors in Pediatric Psoriasis Among Iraqi Patients: A Case-Control Study. Cureus 2021; 13:e18397. [PMID: 34729275 PMCID: PMC8556718 DOI: 10.7759/cureus.18397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Psoriasis is a polygenic multifactorial immune-mediated skin disease associated with comorbidities. As one-third of adult psoriasis starts during childhood, early detection of these comorbidities might help to mitigate their impact on future health. Objectives: To investigate the risk for cardiovascular events and their relationship with psoriasis severity among Iraqi children and adolescents. Patients and methods: A prospective, case-control, cross-sectional study on 150 patients with psoriasis and 150 age and sex-matched individuals. The study was carried out at the Department of Dermatology/Basra Teaching Hospital from December 2018 to December 2020. Psoriasis severity was assessed by PASI (psoriasis area severity index) score, and in both groups, blood pressure and body mass index (BMI) were measured. Laboratory tests including fasting blood sugar (FBS) and lipid profile were also done. Results: More patients were overweight and obese in the psoriatic group compared to the control group (26.7% and 40% versus 11% and 8%), 5.3% of psoriatic patients who had stage 2 hypertension (defined as any blood pressure [BP] measurement higher than 99th plus 5 mm of mercury applied to BP levels for boys and girls by age and height percentile charts), none of the control group was hypertensive, and the difference was statistically significant (p-value<0.05). A significantly higher proportion of the psoriatic patients had abnormal lipid profiles compared with the control group, 62% versus 30% (p<0.05), 15.3% versus 6.7% had elevated cholesterol (p<0.05), 24.7% versus 8% had raised low-density lipoprotein (LDL, p<0.05), 18% versus 8.6% had low high-density lipoprotein (HDL, p<0.05), and 12.6% versus 6% had elevated very-low-density lipoprotein (VLDL) and triglyceride (TG, p<0.05), 8% patients had elevated FBS (more than 100 mg per deciliter) versus 2.6% (p<0.05), and metabolic syndrome in 65 versus 2% (p<0.05). These changes were related to the severity of psoriasis. Conclusions: Pediatric psoriatic patients in our population may have an atherogenic lipid profile with an increased prevalence of risk factors for cardiovascular diseases, especially those with moderate to severe psoriasis.
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Affiliation(s)
- Samer A Dhaher
- Dermatology, College of Medicine, University of Basrah, Basrah, IRQ
| | - Farah Alyassiry
- Department of Dermatology, Basrah Teaching Hospital, Basrah, IRQ
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Katakam BK, Munisamy M, Rao TN, Chiramel MJ, Panda M, Gupta S, Pss R, Seetharam KA. Recommendations for Management of Childhood Psoriasis. Indian Dermatol Online J 2021; 12:S71-S85. [PMID: 34976883 PMCID: PMC8664175 DOI: 10.4103/idoj.idoj_965_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/09/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Childhood psoriasis is recognized as a potential multisystem disorder and hence it is imperative to optimize disease management to arrest progression, minimize psychological burden and evolution of metabolic syndrome. Clinical practice recommendations are necessary to assist practitioners in appropriate decision making based on available evidence. Owing to the lack of Indian recommendations on childhood psoriasis, the SIG Pediatric Dermatology under IADVL Academy undertook an evidence-based approach based on published literature on the topic, between January 2000 and July 2020 to frame the recommendations.
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Affiliation(s)
- Bhumesh Kumar Katakam
- Dermatology, Venereology and Leprology, Gandhi Medical College, Secunderabad, Telangana, India
| | - Malathi Munisamy
- Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | | | - Maitreyee Panda
- Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sandeep Gupta
- Consultant Dermatologist, Balaji Skin Clinic, New Delhi, India
| | - Ranugha Pss
- Dermatology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - K A Seetharam
- Dermatology, GSL Medical College, Rajahmundry, India
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Acewicz M, Kasacka I. Chemerin activity in selected pathological states of human body - A systematic review. Adv Med Sci 2021; 66:270-278. [PMID: 34082283 DOI: 10.1016/j.advms.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/18/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022]
Abstract
Recent studies have revealed that fatty tissue, so far considered an energy storage organ, is also the source of many substances called adipokines, including chemerin which plays many important functions in the body. Chemerin stimulates adipocytes maturation and differentiation, as well as acts as a chemoattractant, which stimulates innate and acquired immunity. This adipokine participates in the early stages of acute inflammation as well as its suppression by reacting with the CMKLR1 receptor. In various diseases associated with inflammatory processes, the level of chemerin in the serum increases. It is also considered a marker for benign and malignant tumors. Explanation of the pathomechanisms involving this adipokine is of a high importance and may contribute to the development of new possibilities in the treatment of many diseases. The article presents the latest information on the role of chemerin in various pathological states, particularly in psoriasis.
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Affiliation(s)
- Magdalena Acewicz
- Department of Histology and Cytophysiology, Medical University of Bialystok, Bialystok, Poland
| | - Irena Kasacka
- Department of Histology and Cytophysiology, Medical University of Bialystok, Bialystok, Poland.
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6
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Tang L, Yao T, Fang M, Zheng X, Chen G, Li M, Wang D, Li X, Ma H, Wang X, Qian Y, Zhou F. Genomic DNA methylation in HLA-Cw*0602 carriers and non-carriers of psoriasis. J Dermatol Sci 2020; 99:23-29. [PMID: 32522384 DOI: 10.1016/j.jdermsci.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND HLA-Cw*0602 has long been established as one of the most important genetic biomarkers in psoriasis. However, the epigenetic and gene expression differences between HLA-Cw*0602 carriers and non-carriers has not yet been investigated. OBJECTIVE We aim to explore the whole-genome methylation and gene expression differences between HLA-Cw*0602 carriers and non-carriers. METHODS HLA imputation was performed to get landscape of variants in this region. Genome-wide DNA methylation was compared between positive and negative HLA-Cw*0602 groups. Eleven methylation loci were selected for further validation in additional 43 cases. For differentially methylated genes, GO and KEGG were used to annotate gene functions. RESULTS We imputed 29,948 variants based on the constructed HLA reference panels, and obtained 42 HLA-Cw*0602 carriers and 72 non-carriers. Significant methylation differences were detected at 4321 sites (811 hypo- and 3510 hypermethylated). The cg02607779 (KLF7, P = 0.001), cg06936779 (PIP5K1A, P = 0.002), cg03860400 (BTBD10, P = 0.017) and cg26112390 (GOLGA2P5, P = 0.019) were identified and validated to be the significant CpGs contributed to different HLA-C*0602 groups. Among the hypo- and hypermethylated sites, the top CpGs were in gene body and CpG island. CONCLUSION We performed the first whole-genome study on methylation differences between psoriatic individuals with or without HLA-Cw*0602, and found the key methylation sites which may contribute to the carrying status of HLA-Cw*0602. Methylation loci located in gene body and CpG island are more likely to affect the methylation levels in HLA-Cw*0602 carriers. This integrated analysis shed light on novel insights into the pathogenic mechanisms of genomic methylation in different HLA genotypes of psoriasis.
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Affiliation(s)
- Lili Tang
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Tianyu Yao
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Miaohong Fang
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Xiaodong Zheng
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Gang Chen
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Mengqing Li
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Dan Wang
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Xinyu Li
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Haining Ma
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Xiangru Wang
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Yunhong Qian
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Fusheng Zhou
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China.
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Tekin B, Gurel MS, Topkarci Z, Topaloglu Demir F, Aytekin S, Cebeci Kahraman F, Singer R, Erdemir VA, Uzuncakmak TK, Yasar S, Akdeniz N, Altunay IK, Kocaturk E, Turkoglu Z, Erdogan B. Assessment of quality of life in Turkish children with psoriasis and their caregivers. Pediatr Dermatol 2018; 35:651-659. [PMID: 29984848 DOI: 10.1111/pde.13585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES The effect of pediatric psoriasis on quality of life has been demonstrated, but data regarding its influence on caregiver quality of life are scarce. The objective was to investigate how psoriasis affects quality of life of children and their caregivers. METHODS This multicenter study included 129 children with psoriasis and their caregivers, who were family members accompanying patients to the clinic. Patient quality of life was measured using the Child Dermatology Life Quality Index. Caregiver quality of life was assessed using Dermatological Family Impact Scale, a 15-item questionnaire validated for use in the Turkish language. RESULTS Mean Child Dermatology Life Quality Index score was 7.6, indicating a moderate effect on patient quality of life. Symptoms and feelings were the most severely impaired domains of patient quality of life, and emotions was the most severely impaired domain of caregiver quality of life. Dermatological Family Impact Scale score was significantly correlated with Child Dermatology Life Quality Index (correlation coefficient [r] = .554, P < .001) and Psoriasis Area and Severity Index (r = .350, P < .001). Caregivers of patients receiving systemic agents or phototherapy had relative impairment of multiple domains of quality of life compared to caregivers of patients receiving topical treatment only. CONCLUSION Psychosocial effect of pediatric psoriasis was shown to extend beyond the individual, highlighting the importance of addressing patient and caregiver quality of life concerns in an integrated approach.
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Affiliation(s)
- Burak Tekin
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Zeynep Topkarci
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | | | - Sema Aytekin
- Department of Dermatology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Filiz Cebeci Kahraman
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ralfi Singer
- Department of Dermatology, Okmeydani Research and Training Hospital, Istanbul, Turkey
| | - Vefa Asli Erdemir
- Department of Dermatology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Tugba Kevser Uzuncakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sirin Yasar
- Department of Dermatology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ilknur Kivanc Altunay
- Department of Dermatology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Okmeydani Research and Training Hospital, Istanbul, Turkey
| | - Zafer Turkoglu
- Department of Dermatology, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Bilgen Erdogan
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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8
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Abstract
Psoriasis is a multifactorial disease with a strong genetic background. HLA-Cw6 is one of the most strongly associated psoriasis susceptibility alleles. It is repeatedly observed to affect disease course, phenotypic features, severity, comorbidities and treatment outcomes. To the best of our knowledge, the roles of HLA-Cw6 in psoriasis have not yet been thoroughly reviewed. The worldwide frequency of the HLA-Cw6 allele varies greatly, with it being generally higher in white people than in Asians. The allele is associated with type I early-onset psoriasis. Stress, obesity and streptococcal pharyngitis are commonly observed in HLA-Cw6-positive patients. Phenotypically, HLA-Cw6 has been found to be associated with guttate psoriasis. In addition, patients carrying the allele are more likely to have arm, leg and trunk involvement, and the Koebner phenomenon. Patients with psoriatic arthritis with HLA-Cw6 more often have early onset and tend to show cutaneous symptoms before musculoskeletal symptoms. HLA-Cw6-positive patients have been shown in several studies to be more responsive to methotrexate and ustekinumab. However, this difference in ustekinumab efficacy was only moderate in a post-hoc analysis of a pivotal phase III study. HLA-Cw6 positivity also tends to be less frequent in high-need patients who fail conventional therapy. Small studies have also investigated the role of HLA-Cw6 in remission of psoriasis during pregnancy, and with the comorbidities of photosensitivity and atherosclerosis. Given the diverse nature of psoriasis pathogenesis, as well as the difference of HLA-Cw6 positivity in different ethnic groups, more studies are needed to confirm the role of HLA-Cw6 in psoriasis.
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Affiliation(s)
- L Chen
- Lake Erie College of Osteopathic Medicine, Bradenton, PA, U.S.A
| | - T-F Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
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9
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Eichenfield LF, Paller AS, Tom WL, Sugarman J, Hebert AA, Friedlander SF, Siegfried E, Silverberg N, Cordoro KM. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol 2018; 35:170-181. [PMID: 29314219 DOI: 10.1111/pde.13382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Adelaide A Hebert
- Pediatric Dermatology, McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Department of Dermatology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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10
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Abstract
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
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Affiliation(s)
- Andy C Hsi
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ilana S Rosman
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
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11
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Chen P, Li C, Xue R, Chen H, Tian X, Zeng K, Zhang X, Liang J. Efficacy and safety of acitretin monotherapy in children with pustular psoriasis: results from 15 cases and a literature review. J DERMATOL TREAT 2017; 29:353-363. [PMID: 29098909 DOI: 10.1080/09546634.2017.1395798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Changxing Li
- Department of Dermatology, Dongguan Sixth People’s Hospital, Dongguan, P.R. China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Huiheng Chen
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Xin Tian
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
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12
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Subedi S, Yu Q, Chen Z, Shi Y. Management of pediatric psoriasis with acitretin: A review. Dermatol Ther 2017; 31. [PMID: 29094450 DOI: 10.1111/dth.12571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
Psoriasis is a chronic inflammatory disease of the skin which can occur at any age-group. Psoriasis in childhood is not uncommon and has genetic susceptibility but usually, an environmental trigger such as infection is thought to initiate the disease process. Pediatric psoriasis has profound effects on both physical and psychosocial health of the patient. Treatment of mild psoriasis can be done with topical therapies but those which do not respond to topical therapies can be treated with phototherapy and systemic therapies. The use of systemic therapies in childhood is mainly based on the published data, case series, expert opinion and the experience as there is the lack of controlled trials in the age group. Based on the experience retinoids are probably the second line drugs for the treatment of pediatric psoriasis which do not respond to topical therapies and phototherapy. Using acitretin in a low dose and with proper physical examinations and laboratory investigations will reduce the hazard of potential serious adverse events. This article gives the review of the use of acitretin in pediatric psoriasis.
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Affiliation(s)
- Smriti Subedi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Qian Yu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zeyu Chen
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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13
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Lau BW, Lim DZ, Capon F, Barker JN, Choon SE. Juvenile generalized pustular psoriasis is a chronic recalcitrant disease: an analysis of 27 patients seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol 2017; 56:392-399. [PMID: 28194751 DOI: 10.1111/ijd.13489] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/10/2016] [Accepted: 09/12/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limited information exists regarding juvenile generalized pustular psoriasis (GPP). We aim to determine the clinical profile and outcome of Malaysians with juvenile GPP. METHODS Review of hospital case notes on patients with juvenile GPP. RESULTS Twenty-seven patients with juvenile GPP were identified. Female to male ratio was 1.4:1. The median age at onset of GPP was 6.5 years. Ten patients had prior psoriasis with a median pre-pustular duration of 2.7 years. Onset of GPP was earlier in patients without prior psoriasis (5.1 years vs. 12.0 years, P = 0.002). Precipitating factors identified included stress, upper respiratory tract infection, systemic steroid use, vaccination, and pregnancy. A positive family history of psoriasis and GPP was present in six and one patient(s), respectively. Twenty-one patients had acute, five annular, and one localized variant of GPP. Arthritis was present in 22.2%. Fever, leukocytosis, and transaminitis were mainly seen in patients with acute GPP at 80.9, 72.2, and 11.1%, respectively. Among 20 patients screened, eight carry IL36RN variants and one has CARD14 mutation. IL36RN-positive patients have more severe disease characterized by early onset, low prevalence of prior plaque psoriasis, high prevalence of systemic inflammation, and need for continuous long-term systemic therapy. Acitretin and cyclosporine were effective in aborting acute GPP in 100% of 16 and 66.7% of six patients treated, respectively. However, relapses were common. Only three of the 17 patients whose initial acute GPP was controlled with systemic agents were successfully weaned off treatment. CONCLUSIONS Juvenile GPP is a chronic recalcitrant disease. IL36RN-positive patients have more severe disease.
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Affiliation(s)
- Bi-Wen Lau
- School of Medicine and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Dee-Zhen Lim
- School of Medicine and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Francesca Capon
- Division of Genetics and Molecular Medicine, King's College, London, UK
| | - Jonathan N Barker
- Division of Genetics and Molecular Medicine, King's College, London, UK
| | - Siew-Eng Choon
- Department of Dermatology Hospital Sultanah Aminah, Johor Bahru, Malaysia
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14
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Saikaly SK, Mattes M. Biologics and Pediatric Generalized Pustular Psoriasis: An Emerging Therapeutic Trend. Cureus 2016; 8:e652. [PMID: 27462478 PMCID: PMC4959817 DOI: 10.7759/cureus.652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Generalized pustular psoriasis (GPP) is a rare form of childhood psoriasis, often requiring systemic therapy, which is challenging as there is a paucity of randomized controlled trials and standardized guidelines. Biologic agents have been used in adults and in pediatric plaque psoriasis, but evidence regarding their efficacy in pediatric GPP has slowly become available. The objective of this study is to summarize and compare the efficacy and safety of biologic agents, such as etanercept, infliximab, and adalimumab, in the treatment of pediatric GPP. A PubMed literature review was conducted and 12 studies met the inclusion criteria for analysis. After reviewing the efficacy of these drugs in pediatric GPP patients and their safety in the use of other pediatric conditions, etanercept was identified as a possible first-line biologic agent for pediatric psoriasis, including GPP, followed by infliximab and adalimumab. In conclusion, several case reports have documented the successful use of biologic agents in refractory cases of pediatric GPP, but clinical trials are needed to gain a better understanding of the efficacy and side effect profile in this population.
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Affiliation(s)
- Sami K Saikaly
- College of Medicine, University of Central Florida College of Medicine
| | - Monica Mattes
- College of Medicine, University of Central Florida College of Medicine
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15
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Burden‐Teh E, Thomas K, Ratib S, Grindlay D, Adaji E, Murphy R. The epidemiology of childhood psoriasis: a scoping review. Br J Dermatol 2016; 174:1242-57. [DOI: 10.1111/bjd.14507] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. Burden‐Teh
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - K.S. Thomas
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - S. Ratib
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - D. Grindlay
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - E. Adaji
- Division of Epidemiology & Public Health University of Nottingham Nottingham U.K
| | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust Sheffield U.K
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16
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Klufas DM, Wald JM, Strober BE. Treatment of Moderate to Severe Pediatric Psoriasis: A Retrospective Case Series. Pediatr Dermatol 2016; 33:142-9. [PMID: 26871417 DOI: 10.1111/pde.12782] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psoriasis has an estimated prevalence of 0.5% to 2.0% in children. There is a paucity of data regarding the management and safety of treatments currently available for children with moderate to severe psoriasis. The aim of this study was to evaluate the treatment response and safety of systemic therapies used to manage moderate to severe pediatric psoriasis in a single referral center. Despite a small sample size, it was hypothesized that multiple therapeutics used for adult psoriasis would have a similar side-effect profile and positive disease response when used in a pediatric population. METHODS A retrospective case series evaluated 51 children with moderate to severe psoriasis treated with systemic therapies for adverse event occurrence and for disease response using a 5-point Physician Global Assessment scale. RESULTS Fifty-one patients, some of whom used multiple treatment options, produced 80 treatment data points. Adverse events were reported in 29 of these 80 treatments, with most being minor, subjective side effects. Overall, the most commonly reported side effect was fatigue, which was reported in 7.5% of treatments. Because of the small sample size, the data collected are limited and may not represent a comprehensive safety profile, nor do they allow comparison of efficacy between therapies. This case series found that biologic and immunomodulating therapies provide well-tolerated treatments with positive disease response for moderate to severe pediatric psoriasis. CONCLUSION Although sample size and study design limit the data from this study, the study provides some guidance where little exists and helps to support the use of these treatments in this setting.
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Affiliation(s)
- Daniel M Klufas
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Jenna M Wald
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Bruce E Strober
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.,Probity Medical Research, Waterloo, Ontario, Canada
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17
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Bulbul Baskan E, Yazici S, Tunali S, Saricaoglu H. Clinical experience with systemic cyclosporine A treatment in severe childhood psoriasis. J DERMATOL TREAT 2015; 27:328-31. [DOI: 10.3109/09546634.2015.1115813] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Augustin M, Radtke MA, Glaeske G, Reich K, Christophers E, Schaefer I, Jacobi A. Epidemiology and Comorbidity in Children with Psoriasis and Atopic Eczema. Dermatology 2015; 231:35-40. [PMID: 25966818 DOI: 10.1159/000381913] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND First studies have shown that juvenile psoriasis is associated with an increased prevalence of comorbidity. OBJECTIVES We carried out a data analysis to characterise the profiles of comorbidity in children with psoriasis and atopic eczema. METHODS Prevalence data were derived from the database of a German statutory health insurance company according to ICD-10 codes L40 (psoriasis) and L20 (atopic eczema) of children up to 18 years insured in 2009. RESULTS Data sets included 1.64 million persons and 293,181 children. 1,313 children = 0.45% (0.42-0.47) had a diagnosis of psoriasis and 30,354 = 10.35% (10.24-10.47) had a diagnosis of atopic eczema. Obesity, hyperlipidaemia, arterial hypertension and diabetes were more often diagnosed in children with psoriasis in comparison to all children without psoriasis and to those with atopic eczema. CONCLUSION Children with psoriasis and atopic eczema show different and specific patterns of comorbidity which should be detected early and treated adequately.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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19
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Piraccini BM, Triantafyllopoulou I, Prevezas C, Starace M, Neri I, Patrizi A, Caserini M, Palmieri R, Rigopoulos D. Nail Psoriasis in Children: Common or Uncommon? Results from a 10-Year Double-Center Study. Skin Appendage Disord 2015; 1:43-8. [PMID: 27172521 DOI: 10.1159/000377709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE OF THE STUDY Our aim was to perform an extensive search of the literature on the prevalence of nail psoriasis in the pediatric population and to estimate it on our own database. PROCEDURES Searching the most important databases yielded results of 16 papers published in a 40-year period which reported the prevalence of nail psoriasis in children. Furthermore, data gathered between 2004 and 2013 at two centers specialized in nail disorders were analyzed. RESULTS The selected papers encompassed a total of 4,853 psoriatic children, of whom 762 (15.7%) had nail involvement. Concerning our data, a total of 68,839 children were seen in pediatric skin consultation in both clinics over a period of 10 years, 0.11% of which had nail involvement. The rate of psoriatic children presenting nail alterations was 19.4% in the Greek and 15.5% in the Italian patient groups. CONCLUSIONS AND MESSAGE This is the retrospective study including the largest number of cases of nail psoriasis in the pediatric population. Our data are in line with the incidence estimation of the rest of Europe.
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Affiliation(s)
- Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Christos Prevezas
- Nail Disorders Unit, Second Department of Dermatology, Attikon University Hospital, Athens, Greece
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | | | - Dimitrios Rigopoulos
- Nail Disorders Unit, Second Department of Dermatology, Attikon University Hospital, Athens, Greece
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20
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Lam M, Burden-Teh E, Taibjee S, Taylor A, Webster S, Dolman S, Jury C, Caruana D, Darne S, Carmichael A, Natarajan S, McPherson T, Moore A, Katugampola R, Kalavala M, Al-Ismail D, Richards L, Jones V, Batul Syed S, Glover M, Hughes J, Anderson E, Hughes B, Babakinejad P, Murphy R. A U.K. multicentre audit of the assessment and management of psoriasis in children. Br J Dermatol 2015; 172:789-92. [PMID: 25308153 DOI: 10.1111/bjd.13471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M.L. Lam
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
| | - E. Burden-Teh
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
| | - S.M. Taibjee
- Department of Dermatology; Dorset County Hospital; Dorset U.K
| | - A. Taylor
- Department of Dermatology; The Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne U.K
| | - S. Webster
- Department of Dermatology; Alder Hey Children's Hospital; West Derby U.K
| | - S. Dolman
- Department of Dermatology; Alder Hey Children's Hospital; West Derby U.K
| | - C. Jury
- Department of Dermatology; Royal Hospital for Sick Children; Glasgow U.K
| | - D. Caruana
- Department of Dermatology; Royal Hospital for Sick Children; Glasgow U.K
| | - S. Darne
- Department of Dermatology; The James Cook University Hospital; Middlesbrough U.K
| | - A. Carmichael
- Department of Dermatology; The James Cook University Hospital; Middlesbrough U.K
| | - S. Natarajan
- Department of Dermatology; The James Cook University Hospital; Middlesbrough U.K
| | - T. McPherson
- Department of Dermatology; Churchill Hospital; Oxford U.K
| | - A. Moore
- Department of Dermatology; Churchill Hospital; Oxford U.K
| | - R. Katugampola
- Department of Dermatology; University Hospital Wales; Cardiff U.K
| | - M. Kalavala
- Department of Dermatology; University Hospital Wales; Cardiff U.K
| | - D. Al-Ismail
- Department of Dermatology; University Hospital Wales; Cardiff U.K
| | - L. Richards
- Department of Dermatology; University Hospital Wales; Cardiff U.K
| | - V. Jones
- Department of Dermatology; Royal Cornwall Hospital NHS Trust; Cornwall U.K
| | - S. Batul Syed
- Department of Dermatology; Great Ormond Street Hospital for Children NHS Foundation Trust; London U.K
| | - M. Glover
- Department of Dermatology; Great Ormond Street Hospital for Children NHS Foundation Trust; London U.K
| | - J. Hughes
- Department of Dermatology; Princess of Wales Hospital; Bridgend U.K
| | - E. Anderson
- Department of Dermatology; Princess of Wales Hospital; Bridgend U.K
| | - B. Hughes
- Department of Dermatology; Portsmouth Hospitals NHS Trust; Portsmouth U.K
- Department of Dermatology; St Richards Hospital; Chichester U.K
| | - P. Babakinejad
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
| | - R. Murphy
- Department of Dermatology; Queen's Medical Centre; Nottingham U.K
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21
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Bronckers IMGJ, Paller AS, van Geel MJ, van de Kerkhof PCM, Seyger MMB. Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities. Paediatr Drugs 2015; 17:373-84. [PMID: 26072040 PMCID: PMC4744260 DOI: 10.1007/s40272-015-0137-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Psoriasis is a common chronic immune-mediated inflammatory skin disorder and begins in childhood in almost one-third of the cases. Although children present with the same clinical subtypes of psoriasis seen in adults, lesions may differ in distribution and morphology, and their clinical symptoms at presentation may vary from those reported by adult patients. Nevertheless, diagnosis of psoriasis is primarily based on clinical features. Pediatric psoriasis can have a profound long-term impact on the psychological health of affected children. Additionally, pediatric psoriasis has been associated with certain comorbidities, such as obesity, hypertension, hyperlipidemia, diabetes mellitus and rheumatoid arthritis, making early diagnosis and management essential. As guidelines are lacking and most (systemic) treatments are not approved for use in children, treatment of pediatric psoriasis remains a challenge. A prospective, multicenter, international registry is needed to evaluate these treatments in a standardized manner and ultimately to develop international guidelines on pediatric psoriasis. This article reviews current concepts in pediatric psoriasis including epidemiology, clinical features, diagnosis, the role of topical and systemic agents and the association with other morbidities in childhood.
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Affiliation(s)
- I. M. G. J. Bronckers
- />Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A. S. Paller
- />Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - M. J. van Geel
- />Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - P. C. M. van de Kerkhof
- />Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M. M. B. Seyger
- />Department of Dermatology, Radboud University Medical Center, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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22
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Posso-De Los Rios CJ, Pope E, Lara-Corrales I. A systematic review of systemic medications for pustular psoriasis in pediatrics. Pediatr Dermatol 2014; 31:430-9. [PMID: 24890463 DOI: 10.1111/pde.12351] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is lack of information and evidence-based studies on the treatment of pediatric pustular psoriasis. Previous reports have emphasized the limitations of the existing data and encouraged the exploration of therapy optimization through more structured research. The objective of the current study was to perform a systematic review of systemic interventions for pediatric pustular psoriasis with an emphasis on clinical response and treatment outcomes. A systematic literature search was conducted using the PubMed and Embase databases from 1982 to 2012. Of 632 references identified, 14 met our inclusion criteria and were included in the analysis. A cohort of eight patients from the Hospital for Sick Children, Toronto, Canada, was also included. Information was limited to systemic treatments in children. Only English- and Spanish-language articles were included. Information was gathered from 24 patients, 22 of whom (92%) presented with generalized pustular psoriasis and 2 (8%) with acral distribution. The mean age at presentation was 6.3 ± 4.9 years. More than one intervention was required in 12 (50%) cases. The most common therapies used for generalized pustular psoriasis were acitretin, cyclosporine, and methotrexate. We identified that there is lack of information regarding long-term response to systemic drugs because the data were focused on treatment initiation. Treatment of pustular psoriasis in pediatrics is challenging. Although acitretin, methotrexate, and cyclosporine seem to control generalized pustular psoriasis within 3 months of therapy initiation, information on long-term follow-up is lacking. Furthermore, physicians may encounter difficulties after discontinuing or tapering medications.
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Affiliation(s)
- Claudia J Posso-De Los Rios
- Section of Dermatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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23
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Moustou AE, Kakourou T, Masouri S, Alexopoulos A, Sachlas A, Antoniou C. Childhood and adolescent psoriasis in Greece: a retrospective analysis of 842 patients. Int J Dermatol 2014; 53:1447-53. [DOI: 10.1111/ijd.12225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Talia Kakourou
- 1st Pediatric Department; University of Athens Medical School, Aghia Sofia Children's Hospital; Athens Greece
| | - Sofia Masouri
- 1st Department of Dermatology; University of Athens Medical School; Andreas Sygros Hospital; Athens Greece
| | - Alexis Alexopoulos
- 1st Pediatric Department; University of Athens Medical School, Aghia Sofia Children's Hospital; Athens Greece
| | | | - Christina Antoniou
- 1st Department of Dermatology; University of Athens Medical School; Andreas Sygros Hospital; Athens Greece
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24
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Posso-De Los Rios CJ, Pope E. New insights into pustular dermatoses in pediatric patients. J Am Acad Dermatol 2014; 70:767-773. [DOI: 10.1016/j.jaad.2013.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/02/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
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25
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Fotiadou C, Lazaridou E, Ioannides D. Management of psoriasis in adolescence. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:25-34. [PMID: 24729738 PMCID: PMC3961070 DOI: 10.2147/ahmt.s36672] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%–4% of the world’s population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis.
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Affiliation(s)
- Christina Fotiadou
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Demetrios Ioannides
- First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
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Yin X, Wineinger NE, Cheng H, Cui Y, Zhou F, Zuo X, Zheng X, Yang S, Schork NJ, Zhang X. Common variants explain a large fraction of the variability in the liability to psoriasis in a Han Chinese population. BMC Genomics 2014; 15:87. [PMID: 24479639 PMCID: PMC3909441 DOI: 10.1186/1471-2164-15-87] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 01/27/2014] [Indexed: 12/14/2022] Open
Abstract
Background Psoriasis is a common inflammatory skin disease with a known genetic component. Our previously published psoriasis genome-wide association study identified dozens of novel susceptibility loci in Han Chinese. However, these markers explained only a small fraction of the estimated heritable component of psoriasis. To better understand the unknown yet likely polygenic architecture in psoriasis, we applied a linear mixed model to quantify the variation in the liability to psoriasis explained by common genetic markers (minor allele frequency > 0.01) in a Han Chinese population. Results We explored the polygenic genetic architecture of psoriasis using genome-wide association data from 2,271 Han Chinese individuals. We estimated that 34.9% (s.e. = 6.0%, P = 9 × 10-9) of the variation in the liability to psoriasis is captured by common genotyped and imputed variants. We discuss these results in the context of the strong association between HLA variants and psoriasis. We also show that the variance explained by each chromosome is linearly correlated to its length (R2 = 0.27, P=0.01), and quantify the impact of a polygenic effect on the prediction and diagnosis of psoriasis. Conclusions Our results suggest that psoriasis has a substantial polygenic component, which not only has implications for the development of genetic diagnostics and prognostics for psoriasis, but also suggests that more individual variants contributing to psoriasis may be detected if sample sizes in future association studies are increased.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nicholas J Schork
- Institute of Dermatology, Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province 230032, China.
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Mercy K, Kwasny M, Cordoro KM, Menter A, Tom WL, Korman N, Belazarian L, Armstrong AW, Levy ML, Paller AS. Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States. Pediatr Dermatol 2013; 30:424-8. [PMID: 23360462 PMCID: PMC3641153 DOI: 10.1111/pde.12072] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The clinical features of pediatric psoriasis warrant further attention. A national study was conducted to determine the prevalence of scalp and nail involvement and a history of guttate psoriasis at onset according to age, sex, and disease severity. One hundred eighty-one children ages 5 to 17 years with plaque psoriasis were enrolled in a multicenter, cross-sectional study. Subjects and guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to the Physician's Global Assessment and body surface area measures. One hundred forty-three (79.0%) subjects reported a history of scalp involvement, and 71 (39.2%) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.19-0.84) but more likely to have had nail involvement (OR = 3.01, 95% CI = 1.62-5.60). Scalp and nail involvement was not related to psoriasis severity. In contrast, subjects with SP (35.9%) more often reported a history of guttate lesions than did those with MP (21.8%) (p = .02). Antecedent streptococcal infection was more common in children with guttate than those with plaque psoriasis at onset (p = .02) but did not correlate with severity. Sex-related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease. More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.
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Affiliation(s)
- Katherine Mercy
- Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA
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Gånemo A, Wahlgren CF, Svensson Å. Quality of life and clinical features in Swedish children with psoriasis. Pediatr Dermatol 2011; 28:375-9. [PMID: 21736605 DOI: 10.1111/j.1525-1470.2010.01292.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Psoriasis is a common, chronic disease and in one-third of the patients it begins during the first 2 decades of life. The burdens of psoriasis are many, and some can be assessed with quality of life questionnaires. The aim was to investigate the impact of childhood psoriasis on quality of life in children and their parents and to correlate certain clinical findings with quality of life. Forty-five Swedish children (4-16 years, 28 girls) with psoriasis, and their parents, were investigated with the validated questionnaires Children's Dermatology Life Quality Index (5-16 years, n = 42), The Infant's Dermatitis Quality of Life Index (4 years, n = 3), and Dermatitis Family Impact (n = 45), the two latter with the word eczema replaced by psoriasis. Clinical examination was performed, and psoriasis severity was scored with Psoriasis Area and Severity Index. Chronic plaque psoriasis was the most common clinical type (87%). Four of the children had joint complaints. Ninety-three percent had pruritus the preceding 3 days. Ninety-three percent were receiving treatment. Median Psoriasis Area and Severity Index score was 3.3 (range 0.5-12.3). Median score for the Infant's Dermatitis Quality of Life Index was 4.0 (range 2-12), for Children's Dermatology Life Quality Index 4.0 (0-24), and for Dermatitis Family Impact questionnaire 4.0 (0-25). No significant gender difference existed. The Children's Dermatology Life Quality Index scores were higher for younger (5-8 yrs) than older (9-16 yrs) children and higher for those with joint complaints. The Dermatitis family impact scores correlated significantly with Children's Dermatology Life Quality Index and Psoriasis Area and Severity Index scores, but the Children's Dermatology Life Quality Index did not correlate with Psoriasis Area and Severity Index. The Visual Analog Scale and quality of life scores were significantly correlated. Psoriasis in children affects quality of life in the subjects and their parents. Joint complaints and pruritus significantly impair quality of life.
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Affiliation(s)
- Agneta Gånemo
- Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.
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Chiam LYT, de Jager MEA, Giam YC, de Jong EMGJ, van de Kerkhof PCM, Seyger MMB. Juvenile psoriasis in European and Asian children: similarities and differences. Br J Dermatol 2011; 164:1101-3. [PMID: 21418172 DOI: 10.1111/j.1365-2133.2010.10196.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The first manifestations of psoriasis begin in childhood in more than one-third of patients. However, epidemiological data of juvenile psoriasis are lacking. OBJECTIVES To compare Dutch (NL group) and Singaporean (SG group) children with psoriasis with the aim of studying the characteristics of juvenile psoriasis and to highlight similarities and differences between these different ethnic groups. METHODS Data were collected from 207 patients younger than 18 years diagnosed with psoriasis from Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands and the National Skin Centre, Singapore. RESULTS A striking difference in familial distribution was found, with more Dutch children having an affected family member (73·3% vs. 13·6%). Presence of itch and triggering factors were more common among Dutch children (80% vs. 14·2% and 33·3% vs. 7·4%, respectively). However, both groups shared similar triggering factors like stress and infections. Other similarities included mean age at presentation (NL group 11·3 years; SG group 14·1 years) and gender ratio (NL group, M/F 1 : 1·1; SG group, M/F 1 : 1·4). Plaque psoriasis was the most common type in both cohorts while guttate and pustular psoriasis were rare. In both groups, the head, followed by the limbs, was the most common site involved. Similar proportions of children in both countries had nail involvement and psoriatic arthritis was rare. CONCLUSIONS The disparity in familial distribution may point to genetic differences between the two groups. Further studies to evaluate this difference in familial distribution may contribute to the understanding of the pathogenesis of psoriasis.
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Affiliation(s)
- L Y T Chiam
- National Skin Centre, 1 Mandalay Road, Singapore 308205.
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Childhood psoriasis: a study of 137 cases from central China. World J Pediatr 2010; 6:260-4. [PMID: 20549408 DOI: 10.1007/s12519-010-0213-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Childhood psoriasis is common, but it has not been adequately reported in China. This study was undertaken to evaluate the epidemiological and clinical findings in children with psoriasis treated in a 9-year period and to compare the data with those from other studies. METHODS The data were from 137 children (< or =14 years old) with psoriasis registered in two tertiary hospitals in Wuhan, China between January 2000 and December 2008. They were retrospectively studied. RESULTS Of the 137 patients, aged between 3 and 14 years, 64 were males (46.7%) and 73 females (53.3%). Eleven patients (8%) had a family history of psoriasis. Infection was the most common precipitating factor (39, 28.5%). Seasonal influence was found in 57 patients (41.6%). Exacerbations in winter and spring were noted in 29 and 16 patients respectively. Plaque psoriasis was the most common type (72 patients, 52.6%), followed by guttate psoriasis (35, 25.5%), psoriasis pustulosa (15, 10.9%), and psoriasis erythroderma (7, 5.1%). The scalp was the most common initial site affected (69, 50.3%). Nail changes were found in 35 patients (25.5%), but no mucosal involvements were observed. Five patients had arthralgia and two showed abnormal X-ray appearance. Most of the affected children had pruritus. The co-morbidities of childhood psoriasis included allergic contact dermatitis (31, 22.6%), eczema (6, 4.3%), vitiligo (5, 3.6%), and alopecia areata (3, 2.2%). Psoriasis was sometimes misdiagnosed as dermatitis seborrheica (11, 8.0%), neurodermatitis (9, 6.6%) and balanitis (7, 5.1%). Some patients were treated with steroids, but there were obvious side-effects after longterm administration. Thiamphenicol was effective in the treatment of refractory psoriasis pustulosa in children. CONCLUSIONS Our findings differ from those of previous studies, showing a lower rate of family history and a higher incidence of severe psoriasis. Differential diagnosis should be made especially when lesions occur at the scalp, elbow or balanus. Allergic contact dermatitis takes place more frequently in children with psoriasis than in normal children. Systemic corticosteroids should not be routinely used and other safer and more effective treatments are needed for severe cases.
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Clabaut A, Viseux V. Prise en charge du psoriasis de l’enfant. Ann Dermatol Venereol 2010; 137:408-15; quiz 401, 417. [DOI: 10.1016/j.annder.2010.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 09/27/2009] [Indexed: 01/29/2023]
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Clinical comparison of psoriasis in Korean adults and children: correlation with serum anti-streptolysin O titers. Arch Dermatol Res 2010; 302:295-9. [PMID: 20063005 DOI: 10.1007/s00403-009-1025-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 12/17/2009] [Accepted: 12/29/2009] [Indexed: 12/18/2022]
Abstract
Psoriasis is a relatively common disorder in children and can be triggered by an upper respiratory tract infection. The aim of this study was to compare the clinical features of psoriasis in children and adult. In addition, we evaluated the relationship between anti-streptolysin O (ASO) titers and the clinical features of psoriasis. A total of 30 childhood psoriasis patients and 30 adult psoriasis patients were evaluated. Childhood psoriasis had a facial predominance when compared with the adult psoriasis. The childhood psoriasis patients with high ASO titers had guttate psoriasis more frequently than patients with normal ASO titers. In children with plaque-type psoriasis, psoriasis area and severity index score was increased in the high ASO titer group than normal ASO titer group. In conclusion, if the children with psoriasis show increased ASO titer, the physician should pay attention to the worsening of the psoriasis. Furthermore, early treatment of streptococcal infections might be beneficial in childhood psoriasis.
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Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol 2009; 62:979-87. [PMID: 19962785 DOI: 10.1016/j.jaad.2009.07.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/03/2009] [Accepted: 07/09/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although psoriasis is considered to have a dual peak in age of onset, currently no studies exist regarding the incidence of psoriasis in children. OBJECTIVE The objective of this study was to determine the incidence of psoriasis in childhood. METHODS A population-based incidence cohort of patients aged younger than 18 years first given the diagnosis of psoriasis between January 1, 1970, and December 31, 1999, was assembled. The complete medical record of each child was reviewed and psoriasis diagnosis was validated by a confirmatory diagnosis in the medical record by a dermatologist or medical record review by a dermatologist. Age- and sex-specific incidence rates were calculated and were age and sex adjusted to 2000 US white population. RESULTS The overall age- and sex-adjusted annual incidence of pediatric psoriasis was 40.8 per 100,000 (95% confidence interval: 36.6-45.1). When psoriasis diagnosis was restricted to dermatologist-confirmed subjects in the medical record, the incidence was 33.2 per 100,000 (95% confidence interval: 29.3-37.0). Incidence of psoriasis in children increased significantly over time from 29.6 per 100,000 in 1970 through 1974 to 62.7 per 100,000 in 1995 through 1999 (P < .001). Chronic plaque psoriasis was the most common type (73.7%), and the most commonly involved sites were the extremities (59.9%) and the scalp (46.8%). LIMITATIONS The population studied was a mostly white population in the upper Midwest. CONCLUSION The incidence of pediatric psoriasis increases with increasing age. There is no apparent dual peak in incidence. The incidence of pediatric psoriasis increased in recent years in both boys and girls.
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Affiliation(s)
- Megha M Tollefson
- Department of Dermatology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Augustin M, Glaeske G, Radtke M, Christophers E, Reich K, Schäfer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol 2009; 162:633-6. [DOI: 10.1111/j.1365-2133.2009.09593.x] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Pediatric psoriasis consists broadly of 3 age groups of psoriatic patients: infantile psoriasis, a self-limited disease of infancy, psoriasis with early onset, and pediatric psoriasis with psoriatic arthritis. About one-quarter of psoriasis cases begin before the age of 18 years. A variety of clinical psoriasis types are seen in childhood, including plaque-type, guttate, erythrodermic, napkin, and nail-based disease. Like all forms of auto-immunity, susceptibility is likely genetic, but environmental triggers are required to initiate disease activity. The most common trigger of childhood is an upper respiratory tract infection. Once disease has occurred, treatment is determined based on severity and presence of joint involvement. Topical therapies, including corticosteroids and calcipotriene, are the therapies of choice in the initial care of pediatric patients. Ultraviolet light, acitretin and cyclosporine can clear skin symptoms, while methotrexate and etanercept can clear both cutaneous and joint disease. Concern for psychological development is required when choosing psoriatic therapies. This article reviews current concepts in pediatric psoriasis and a rational approach to therapeutics.
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Affiliation(s)
- Nanette B Silverberg
- Pediatric and Adolescent Dermatology, St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Pityriasis rosea is a common skin condition seen in children and adults. Whereas pityriasis rosea is a benign condition, it is important to distinguish it from other childhood exanthems. RECENT FINDINGS Pityriasis rosea can present in a variety of manners. Most often a herald patch precedes the generalized eruption, although this is not always the case. Pityriasis rosea may lead to undesirable outcomes when affecting pregnant women. Guttate psoriasis, secondary syphilis, cutaneous lupus erythematosus, capillaritis, pityriasis versicolor, nummular eczema, and cutaneous T-cell lymphoma are important to consider in the differential diagnosis of pityriasis rosea. SUMMARY Pityriasis rosea is self-limiting, usually lasting 1-3 months. Treatment may be considered in certain cases, although there is a paucity of medical studies supporting any definitive treatment. However, treatment may be warranted for other conditions that mimic pityriasis rosea.
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Bellet JS, Chamlin SL, Yan AC, Paller AS. Intertriginous pustular psoriasis. J Am Acad Dermatol 2009; 60:679-83. [DOI: 10.1016/j.jaad.2008.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 12/04/2008] [Accepted: 12/09/2008] [Indexed: 11/15/2022]
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Abstract
PURPOSE OF REVIEW Psoriasis is an important disorder in the adolescent population and has a tremendous physical and psychological impact on patients. It is important to understand the genetics, various clinical presentations, comorbidities, and treatment options associated with psoriasis. RECENT FINDINGS The human leukocyte antigen-C gene likely contains a susceptibility locus for psoriasis. Cytokines interleukin-12 and interleukin-23 have been implicated in the pathogenesis of psoriasis as well. Psoriasis is likely associated with an increased risk of myocardial infarction, metabolic syndrome, Crohn's disease, and depression; it is difficult to assess the implications in the adolescent population. SUMMARY Psoriasis is not rare in the adolescent population. It is important for physicians to be aware of the different clinical presentations as well as the spectrum of treatment options that are available.
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